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Lee SJ, Oh J, Ko YG, Lee S, Chang BC, Lee DY, Kwak YR, Choi D. The Beneficial Effect of Renin-Angiotensin-Aldosterone System Blockade in Marfan Syndrome Patients after Aortic Root Replacement. Yonsei Med J 2016; 57:81-7. [PMID: 26632386 PMCID: PMC4696976 DOI: 10.3349/ymj.2016.57.1.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/28/2015] [Accepted: 06/05/2015] [Indexed: 01/25/2023] Open
Abstract
PURPOSE In this study, we evaluated the long term beneficial effect of Renin-Angiotensin-Aldosterone System (RAAS) blockade therapy in treatment of Marfan aortopathy. MATERIALS AND METHODS We reviewed Marfan syndrome (MFS) patients who underwent aortic root replacement (ARR) between January 1996 and January 2011. All patients were prescribed β-blockers indefinitely. We compared major aortic events including mortality, aortic dissection, and reoperation in patients without RAAS blockade (group 1, n=27) to those with (group 2, n=63). The aortic growth rate was calculated by dividing the diameter change on CT scans taken immediately post-operatively and the latest scan available. RESULTS There were no differences in clinical parameters except for age which was higher in patients with RAAS blockade. In group 1, 2 (7%) deaths, 5 (19%) aortic dissections, and 7 (26%) reoperations occurred. In group 2, 3 (5%) deaths, 2 (3%) aortic dissections, and 3 (5%) reoperations occurred. A Kaplan-Meier plot demonstrated improved survival free from major aortic events in group 2. On multivariate Cox, RAAS blockade was an independent negative predictor of major aortic events (hazard ratio 0.38, 95% confidence interval 0.30-0.43, p=0.002). Mean diameter change in descending thoracic and supra-renal abdominal aorta was significantly higher in patients without RAAS blockade (p<0.05). CONCLUSION In MFS patients who underwent ARR, the addition of RAAS blockade to β-blocker was associated with reduction of aortic dilatation and clinical events.
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Affiliation(s)
- Seung Jun Lee
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Jaewon Oh
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young Guk Ko
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Sak Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Byung Chul Chang
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Do Yun Lee
- Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seoul, Korea
| | - Young Ran Kwak
- Department of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Donghoon Choi
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
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Wemmelund H, Høgh A, Hundborg HH, Johnsen SP, Lindholt JS. Preadmission use of renin-angiotensin blockers and rupture of abdominal aortic aneurysm: a nationwide, population-based study. Pharmacoepidemiol Drug Saf 2015; 25:141-50. [DOI: 10.1002/pds.3913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/01/2015] [Accepted: 10/15/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Holger Wemmelund
- Department of Vascular Surgery; Viborg Regional Hospital; Viborg Denmark
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | - Annette Høgh
- Department of Vascular Surgery; Viborg Regional Hospital; Viborg Denmark
| | - Heidi H. Hundborg
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | - Søren P. Johnsen
- Department of Clinical Epidemiology; Institute of Clinical Medicine, Aarhus University Hospital; Aarhus Denmark
| | - Jes S. Lindholt
- Department of Vascular Surgery; Viborg Regional Hospital; Viborg Denmark
- Department of Cardiothoracic and Vascular Surgery; Odense University Hospital; Odense Denmark
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Tsubaki M, Takeda T, Kino T, Obata N, Itoh T, Imano M, Mashimo K, Fujiwara D, Sakaguchi K, Satou T, Nishida S. Statins improve survival by inhibiting spontaneous metastasis and tumor growth in a mouse melanoma model. Am J Cancer Res 2015; 5:3186-3197. [PMID: 26693069 PMCID: PMC4656740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023] Open
Abstract
Metastatic melanoma is a life-threatening disease for which no effective treatment is currently available. In melanoma cells, Rho overexpression promotes invasion and metastasis. However, the effect of statins on spontaneous metastasis and tumor growth remains unclear. In the present study, we investigated the mechanism of statin-mediated tumor growth and metastasis inhibition in an in vivo model. We found that statins significantly inhibited spontaneous metastasis and tumor growth. Statins inhibited the mRNA expression and enzymatic activities of matrix metalloproteinases (MMPs) in vivo and also suppressed the mRNA and protein expression of very late antigens (VLAs). Moreover, statins inhibited the prenylation of Rho as well as the phosphorylation of LIM kinase, serum response factor (SRF), and c-Fos downstream of the Rho signaling pathway. In addition, statins enhanced p53, p21, and p27 expression and reduced phosphorylation of cyclin-dependent kinase and expression of cyclin D1 and E2. These results indicate that statins suppress Rho signaling pathways, thereby inhibiting tumor metastasis and growth. Furthermore, statins markedly improved the survival rate in a metastasis model, suggesting that statins have potential clinical applications for the treatment of metastatic cancers.
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Affiliation(s)
- Masanobu Tsubaki
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
| | - Tomoya Takeda
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
| | - Toshiki Kino
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
| | - Naoya Obata
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
| | - Tatsuki Itoh
- Department of Food Science and Nutrition, Kinki University School of AgricultureNara, Japan
| | - Motohiro Imano
- Department of Surgery, Kinki University School of MedicineOsakasayama, Osaka, Japan
| | - Kenji Mashimo
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical CenterWakayama, Japan
| | - Daichiro Fujiwara
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical CenterWakayama, Japan
| | - Katsuhiko Sakaguchi
- Department of Pharmacy, Japanese Red Cross Society Wakayama Medical CenterWakayama, Japan
| | - Takao Satou
- Department of Pathology, Kinki University School of MedicineOsakasayama, Osaka, Japan
| | - Shozo Nishida
- Division of Pharmacotherapy, Kinki University School of PharmacyKowakae, Higashi-Osaka, Japan
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54
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Morris DR, Cunningham MA, Ahimastos AA, Kingwell BA, Pappas E, Bourke M, Reid CM, Stijnen T, Dalman RL, Aalami OO, Lindeman JH, Norman PE, Walker PJ, Fitridge R, Bourke B, Dear AE, Pinchbeck J, Jaeggi R, Golledge J. TElmisartan in the management of abDominal aortic aneurYsm (TEDY): The study protocol for a randomized controlled trial. Trials 2015; 16:274. [PMID: 26081587 PMCID: PMC4482315 DOI: 10.1186/s13063-015-0793-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experimental studies suggest that angiotensin II plays a central role in the pathogenesis of abdominal aortic aneurysm. This trial aims to evaluate the efficacy of the angiotensin receptor blocker telmisartan in limiting the progression of abdominal aortic aneurysm. METHODS/DESIGN Telmisartan in the management of abdominal aortic aneurysm (TEDY) is a multicentre, parallel-design, randomised, double-blind, placebo-controlled trial with an intention-to-treat analysis. We aim to randomly assign 300 participants with small abdominal aortic aneurysm to either 40 mg of telmisartan or identical placebo and follow patients over 2 years. The primary endpoint will be abdominal aortic aneurysm growth as measured by 1) maximum infra-renal aortic volume on computed tomographic angiography, 2) maximum orthogonal diameter on computed tomographic angiography, and 3) maximum diameter on ultrasound. Secondary endpoints include change in resting brachial blood pressure, abdominal aortic aneurysm biomarker profile and health-related quality of life. TEDY is an international collaboration conducted from major vascular centres in Australia, the United States and the Netherlands. DISCUSSION Currently, no medication has been convincingly demonstrated to limit abdominal aortic aneurysm progression. TEDY will examine the potential of a promising treatment strategy for patients with small abdominal aortic aneurysms. TRIAL REGISTRATION Australian and Leiden study centres: Australian New Zealand Clinical Trials Registry ACTRN12611000931976 , registered on 30 August 2011; Stanford study centre: clinicaltrials.gov NCT01683084 , registered on 5 September 2012.
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Affiliation(s)
- Dylan R Morris
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
| | | | - Anna A Ahimastos
- Baker IDI Heart and Diabetes Institute and The Department of Cardiovascular Medicine, Alfred Hospital Melbourne, Melbourne, Australia.
| | - Bronwyn A Kingwell
- Baker IDI Heart and Diabetes Institute and The Department of Cardiovascular Medicine, Alfred Hospital Melbourne, Melbourne, Australia.
| | - Elise Pappas
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
| | - Michael Bourke
- Gosford Vascular Services, Gosford, New South Wales, Australia.
| | - Christopher M Reid
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia.
| | - Theo Stijnen
- Leiden University Medical Center, Leiden, The Netherlands.
| | - Ronald L Dalman
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Oliver O Aalami
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Jan H Lindeman
- Leiden University Medical Center, Leiden, The Netherlands.
| | - Paul E Norman
- School of Surgery, University of Western Australia, Perth, WA, Australia.
| | - Philip J Walker
- University of Queensland School of Medicine, Discipline of Surgery and Centre for Clinical Research, and Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
| | - Robert Fitridge
- Department of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Bernie Bourke
- Gosford Vascular Services, Gosford, New South Wales, Australia.
| | - Anthony E Dear
- Eastern Health Clinical School, Department of Medicine, Monash University, Melbourne, Australia.
| | - Jenna Pinchbeck
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
| | - Rene Jaeggi
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
- The Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia.
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55
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Lu H, Aikawa M. Many faces of matrix metalloproteinases in aortic aneurysms. Arterioscler Thromb Vasc Biol 2015; 35:752-4. [PMID: 25810296 DOI: 10.1161/atvbaha.115.305401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hong Lu
- From the Division of Cardiology, Department of Internal Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (H.L.); and Center for Interdisciplinary Cardiovascular Sciences, Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A.).
| | - Masanori Aikawa
- From the Division of Cardiology, Department of Internal Medicine, Saha Cardiovascular Research Center, University of Kentucky, Lexington (H.L.); and Center for Interdisciplinary Cardiovascular Sciences, Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.A.).
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56
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Osinbowale OO, Bazan HA. Descending thoracic aortic aneurysm: case presentation and review. Postgrad Med 2014; 126:68-75. [PMID: 25387215 DOI: 10.3810/pgm.2014.11.2834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Descending thoracic aortic aneurysms, similar to other aneurysms, are often incidentally diagnosed in patients with unrelated complaints. Management of these aneurysms is largely dependent on their size and anatomy. Most individuals with asymptomatic descending thoracic aortic aneurysms may be safely managed with cardiovascular risk factor modification until the aneurysm size reaches 6 cm. A subset of individuals, such as those whose descending thoracic aortic aneurysm measures > 6 cm or in cases of rapid growth, should be offered repair, increasingly performed via an endovascular approach. The higher risk of aneurysm rupture in women poses a unique consideration, although to date no gender-specific consensus screening guideline exists for aneurysmal disease of the thoracic aorta.
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Affiliation(s)
- Olusegun O Osinbowale
- Section of Vascular Medicine, Department of Cardiology, Ochsner Health System, New Orleans, LA.
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57
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Thatcher SE, Zhang X, Howatt DA, Yiannikouris F, Gurley SB, Ennis T, Curci JA, Daugherty A, Cassis LA. Angiotensin-converting enzyme 2 decreases formation and severity of angiotensin II-induced abdominal aortic aneurysms. Arterioscler Thromb Vasc Biol 2014; 34:2617-23. [PMID: 25301841 DOI: 10.1161/atvbaha.114.304613] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Angiotensin-converting enzyme 2 (ACE2) cleaves angiotensin II (AngII) to form angiotensin-(1-7) (Ang-(1-7)), which generally opposes effects of AngII. AngII infusion into hypercholesterolemic male mice induces formation of abdominal aortic aneurysms (AAAs). This study tests the hypothesis that deficiency of ACE2 promotes AngII-induced AAAs, whereas ACE2 activation suppresses aneurysm formation. APPROACH AND RESULTS ACE2 protein was detectable by immunostaining in mice and human AAAs. Whole-body deficiency of ACE2 significantly increased aortic lumen diameters and external diameters of suprarenal aortas from AngII-infused mice. Conversely, ACE2 deficiency in bone marrow-derived cells had no effect on AngII-induced AAAs. In contrast to AngII-induced AAAs, ACE2 deficiency had no significant effect on external aortic diameters of elastase-induced AAAs. Because ACE2 deficiency promoted AAA formation in AngII-infused mice, we determined whether ACE2 activation suppressed AAAs. ACE2 activation by administration of diminazene aceturate (30 mg/kg per day) to Ldlr(-/-) mice increased kidney ACE2 mRNA abundance and activity and elevated plasma Ang-(1-7) concentrations. Unexpectedly, administration of diminazene aceturate significantly reduced total sera cholesterol and very low-density lipoprotein-cholesterol concentrations. Notably, diminazene aceturate significantly decreased aortic lumen diameters and aortic external diameters of AngII-infused mice resulting in a marked reduction in AAA incidence (from 73% to 29%). None of these effects of diminazene aceturate were observed in the Ace2(-/y) mice. CONCLUSIONS These results demonstrate that ACE2 exerts a modulatory role in AngII-induced AAA formation, and that therapeutic stimulation of ACE2 could be a benefit to reduce AAA expansion and rupture in patients with an activated renin-angiotensin system.
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Affiliation(s)
- Sean E Thatcher
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Xuan Zhang
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Deborah A Howatt
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Frederique Yiannikouris
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Susan B Gurley
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Terri Ennis
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - John A Curci
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Alan Daugherty
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.)
| | - Lisa A Cassis
- From the Department of Pharmacology and Nutritional Sciences (S.E.T., F.Y., L.A.C.), Graduate Center for Toxicology (X.Z.), and Saha Cardiovascular Research Center, Department of Internal Medicine (D.A.H., A.D.), University of Kentucky, Lexington; Division of Nephrology, Department of Medicine, Duke University, Durham, NC (S.B.G.); and Department of Surgery, Section of Vascular Surgery, Washington University, St Louis, MO (T.E., J.A.C.).
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Silverberg D, Younis A, Savion N, Harari G, Yakubovitch D, Sheick Yousif B, Halak M, Grossman E, Schneiderman J. Long-term renin-angiotensin blocking therapy in hypertensive patients with normal aorta may attenuate the formation of abdominal aortic aneurysms. ACTA ACUST UNITED AC 2014; 8:571-7. [PMID: 24913570 DOI: 10.1016/j.jash.2014.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
Renin-angiotensin system (RAS) has been implicated in the pathogenesis of abdominal aortic aneurysm (AAA). Angiotensin II type 1 receptor blocker (ARB), when given with angiotensin II prevents AAA formation in mice, but found ineffective in attenuating the progression of preexisting AAA. This study was designed to evaluate the effect of chronic RAS blockers on abdominal aortic diameter in hypertensive patients without known aortic aneurysm. Consecutive hypertensive outpatients (n = 122) were stratified according to antihypertensive therapy they received for 12 months or more, consisting of ARB (n = 45), angiotensin converting enzyme inhibitor (ACE-I; n = 45), or nonARB/nonACE-I (control therapy; n = 32). Abdominal ultrasonography was performed to measure maximal subrenal aortic diameter. Eighty-four patients were reexamined by ultrasonography 8 months later. The correlation between the different antihypertensive therapies and aortic diameter was examined. Aortic diameters were significantly smaller in ARB than in control patients in the baseline and follow-up measurements (P = .004; P = .0004, respectively). Risk factor adjusted covariance analysis showed significant differences between ARB or ACE-I treated groups and controls (P = .006 or P = .046, respectively). Ultrasound that was performed 8 months later showed smaller increases in mean aortic diameters of the ARB and ACE-I groups than in controls. Both ARB and ACE-I therapy attenuated expansion of nonaneurysmal abdominal aorta in humans. These results indicate that RAS blockade given before advancement of aortic medial remodeling may slow down the development of AAA.
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Affiliation(s)
- Daniel Silverberg
- The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Anan Younis
- The Department of Internal Medicine D and Hypertension Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Naphtali Savion
- The Goldschleger Eye Research Institute, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | | | - Dmitry Yakubovitch
- The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Moshe Halak
- The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Ehud Grossman
- The Department of Internal Medicine D and Hypertension Clinic, Sheba Medical Center, Tel Hashomer, Israel
| | - Jacob Schneiderman
- The Department of Vascular Surgery, Sheba Medical Center, Tel Hashomer, Israel; The Gottesdiener Vascular Biology Laboratory, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Rouer M, Xu BH, Xuan HJ, Tanaka H, Fujimura N, Glover KJ, Furusho Y, Gerritsen M, Dalman RL. Rapamycin limits the growth of established experimental abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2014; 47:493-500. [PMID: 24629569 DOI: 10.1016/j.ejvs.2014.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 02/07/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease affecting 4-8% of men older than 60 years. No pharmacologic strategies limit disease progression, aneurysm rupture, or aneurysm-related death. We examined the ability of rapamycin to limit the progression of established experimental AAAs. METHODS AAAs were created in 10-12-week-old male C57BL/6J mice via the porcine pancreatic elastase (PPE) infusion method. Beginning 4 days after PPE infusion, mice were treated with rapamycin (5 mg/kg/day) or an equal volume of vehicle for 10 days. AAA progression was monitored by serial ultrasound examination. Aortae were harvested for histological analyses at sacrifice. RESULTS Three days after PPE infusion, prior to vehicle or rapamycin treatment, aneurysms were enlarging at an equal rate between groups. In the rapamycin group, treatment reduced aortic enlargement by 38%, and 53% at 3 and 10 days, respectively. On histological analysis, medial elastin and smooth muscle cell populations were relatively preserved in the rapamycin group. Rapamycin treatment also reduced mural macrophage density and neoangiogenesis. CONCLUSION Rapamycin limits the progression of established experimental aneurysms, increasing the translational potential of mechanistic target of rapamycin-related AAA inhibition strategies.
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Affiliation(s)
- M Rouer
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - B H Xu
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - H J Xuan
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - H Tanaka
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - N Fujimura
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - K J Glover
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Y Furusho
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - M Gerritsen
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - R L Dalman
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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Malekzadeh S, Fraga-Silva RA, Trachet B, Montecucco F, Mach F, Stergiopulos N. Role of the renin-angiotensin system on abdominal aortic aneurysms. Eur J Clin Invest 2013; 43:1328-38. [PMID: 24138426 DOI: 10.1111/eci.12173] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/31/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a complex degenerative disease, which leads to morbidity and mortality in a large portion of the elderly population. Current treatment options for AAA are quite limited as there is no proven indication for pharmacological therapy and surgery is recommended for AAA larger than 5·5 cm in luminal diameter. Thus, there is a great need to elucidate the underlying pathophysiological cellular and molecular mechanisms to develop effective therapies. In this narrative review, we will discuss recent findings concerning some potential molecular and clinical aspects of the renin-angiotensin system (RAS) in AAA pathophysiology. MATERIALS AND METHODS This narrative review is based on the material found on MEDLINE and PubMed up to April 2013. We looked for the terms 'angiotensin, AT1 receptor, ACE inhibitors' in combination with 'abdominal aortic aneurysm, pathophysiology, pathways'. RESULTS Several basic research and clinical studies have recently investigated the role of the RAS in AAA. In particular, the subcutaneous infusion of Angiotensin II has been shown to induce AAA in Apo56 knockout mice. On the other hand, the pharmacological treatments targeting this system have been shown as beneficial in AAA patients. CONCLUSIONS Emerging evidence suggests that RAS may act as a molecular and therapeutic target for treating AAA. However, several issues on the role of RAS and the protective activities of angiotensin-converting enzyme (ACE) inhibitors and Angiotensin 1 receptors blockers against AAA require further clarifications.
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Affiliation(s)
- Sonaz Malekzadeh
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Peng C, Gu P, Zhou J, Huang J, Wang W. Inhibition of rho-kinase by fasudil suppresses formation and progression of experimental abdominal aortic aneurysms. PLoS One 2013; 8:e80145. [PMID: 24244631 PMCID: PMC3828185 DOI: 10.1371/journal.pone.0080145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 10/10/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Accumulating evidence suggests that inflammatory cell infiltration is crucial pathogenesis during the initiation and progression of abdominal aortic aneurysm (AAA). Given Rho-kinase (ROCK), an important kinase control the actin cytoskeleton, regulates the inflammatory cell infiltration, thus, we investigate the possibility and mechanism of preventing experimental AAA progression via targeting ROCK in mice porcine pancreatic elastase (PPE) model. Methods and Results AAA was created in 10-week-old male C57BL/6 mice by transient intraluminal porcine pancreatic elastase infusion into the infrarenal aorta. The mRNA level of RhoA, RhoC, ROCK1 and ROCK2 were elevated in aneurismal aorta. Next, PPE infusion mice were orally administrated with vehicle or ROCK inhibitor (Fasudil at dose of 200 mg/kg/day) during the period of day 1 prior to PPE infusion to day 14 after PPE infusion. PPE infusion mice treated with Fasudil produced significantly smaller aneurysms as compare to PPE infusion mice treated with vehicle. AAAs developed in all vehicle-treated groups within 14 days, whereas AAAs developed in six mice (66%, 6/9) treated with Fasudil within 14 days. Furthermore, our semi-quantitative histological analysis revealed that blood vessels and macrophages were significantly reduced in Fasudil treated mice during the AAA progression. Finally, when mice with existing AAAs were treated with Fasudil, the enlargement was nearly completely suppressed. Conclusion Fasudil inhibits experimental AAA progression and stabilize existing aneurysms, through mechanisms likely related to impaired mural macrophage infiltration and angiogenesis. These findings suggest that ROCK inhibitor may hold substantial translational value for AAA diseases.
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Affiliation(s)
- Chen Peng
- Department of Vascular Surgery,Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Peng Gu
- Department of Vascular Surgery,Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jing Zhou
- Department of Stomatolog, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianhua Huang
- Department of Vascular Surgery,Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Wang
- Department of Vascular Surgery,Xiangya Hospital, Central South University, Changsha, Hunan, China
- * E-mail:
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Haskett D, Azhar M, Utzinger U, Vande Geest JP. Progressive alterations in microstructural organization and biomechanical response in the ApoE mouse model of aneurysm. BIOMATTER 2013; 3:24648. [PMID: 23628871 PMCID: PMC3749278 DOI: 10.4161/biom.24648] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AAA is a complex disease that leads to a localized dilation of the infrarenal aorta that develops over years. Longitudinal information in humans has been difficult to obtain for this disease, therefore mouse models have become increasingly used to study the development of AAAs. The objective of this study was to determine any changes that occur in the biomechanical response and fiber microstructure in the ApoE−/− AngII mouse model of aneurysm during disease progression. Adult ApoE−/− AngII infused mice along with wild-type controls were taken at 14 and 28 d. Aortas were excised and tested simultaneously for biaxial mechanical response and ECM organization. Data sets were fit to a Fung-type constitutive model to give peak strains and stiffness values. Images from two photon microscopy were quantified in order to assess the preferred fiber alignment and degree of fiber orientation. Biomechanical results found significant differences that were present at 14 d had returned to normal by 28 d along with significant changes in fiber orientation and dispersion indicating remodeling occurring within the aneurysmal wall. This return of some of the normal biomechanical function, in addition the continuing changes that occur in the microstructure suggest a restorative response that occurs in the ApoE−/− AngII infused model after the initial aneurysm formation.
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Affiliation(s)
- Darren Haskett
- Graduate Interdisciplinary Program of Biomedical Engineering; University of Arizona; Tucson, AZ USA
| | - Mohamad Azhar
- Developmental Biology and Neonatal Medicine Program, Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN USA
| | - Urs Utzinger
- Graduate Interdisciplinary Program of Biomedical Engineering; University of Arizona; Tucson, AZ USA; BIO5 Institute; University of Arizona; Tucson, AZ USA; Department of Biomedical Engineering; University of Arizona; Tucson, AZ USA
| | - Jonathan P Vande Geest
- Graduate Interdisciplinary Program of Biomedical Engineering; University of Arizona; Tucson, AZ USA; BIO5 Institute; University of Arizona; Tucson, AZ USA; Department of Biomedical Engineering; University of Arizona; Tucson, AZ USA; Department of Aerospace and Mechanical Engineering; University of Arizona; Tucson, AZ USA
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